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Fetal echocardiography
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Caroline K. Lee, Erik C. Michelfelder, Gautam K. Singh
The first step in the evaluation of the fetal heart is to establish fetal position within the maternal abdomen (vertex, breech, transverse, supine, prone) and to establish fetal left and right sides. From a transverse section of the fetal abdomen, visceral situs is assessed by demonstrating the relative position of the stomach, hepatic vessels, abdominal aorta, and inferior vena cava (IVC). Normal abdominal situs (situs solitus) is characterized by the stomach bubble on the fetal left side, liver with hepatic vessels on the right side, abdominal aorta to the left of the fetal spine, and IVC to the right of the fetal spine and slightly anterior to the aorta (Fig. 3). In situs inversus, there is a mirror-image arrangement of these organs and vessels. Situs ambiguous denotes when neither situs solitus nor inversus is present; this is also referred to as heterotaxy and is commonly associated with complex congenital heart defects and splenic abnormalities (asplenia or polysplenia).
Cardiology
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
The following combinations are associated with severe congenital heart disease: Situs solitus + dextrocardiaSitus inversus + laevocardia
Dextrocardia
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
True dextrocardia tends to be associated with situs abnormalities. Situs, by definition, relates to the fetal left-right orientation and preponderance of derivatives of left- or right-sided embryological elements. Situs can be assessed at various levels, namely abdominal, atrial, and pulmonary levels, and is usually similar at all levels. Situs solitus refers to usual arrangement of left- and right-sided structures with the dorsal aorta in the left side of the fetal abdomen and the IVC on the right. The atrial situs is indicated by the characteristic shape of the atrial appendages (broad in the right and digit-like on the left) and may be either left- or right-sided or ambiguous.
Thoracoscopic total esophagogastrectomy with supercharged colon interposition for the treatment of esophageal adenocarcinoma in situs inversus
Published in Acta Chirurgica Belgica, 2019
Alexandros Charalabopoulos, Ali Kordzadeh, Elias Sdralis, Bruno Lorenzi, Fateh Ahmad
Esophagectomy in situs inversus is rare with only few cases reported. It requires careful planning, as it is challenging to perform. In our case there was ‘reversal’ of abdominal organs (situs inversus abdominus) not combined with thoracic (situs inversus totalis). That made right chest thoracoscopic approach possible without deviating from the standard technique. An abdominal laparoscopic approach for stomach and colon mobilization, although theoretically feasible, was found to be challenging and was predicted time-consuming in an already prolonged operation. Surgeons were not used to situs inversus anatomy and in addition to an operation where identification and preservation of the colonic vasculature is of paramount importance, a laparoscopic approach was found unsafe and cannot be recommended. Furthermore, laparoscopic instruments like the Nathanson’s liver retractor are designed for the normal arrangement of organs (situs solitus) and were found impossible to use in situs inversus.
Prenatal Diagnosis of Isolated Right Ventricular Non-Compaction Cardiomyopathy with an MYH7 Likely Pathogenic Variant
Published in Fetal and Pediatric Pathology, 2023
Weiming Yu, Mary Ann Thomas, Lindsay Mills, James R. Wright
The heart was located in a levocardia position with left axis deviation due to an enlarged right ventricle. The heart demonstrated situs solitus of atria, and D-looped ventricles. The right atrium was markedly dilated. The foramen ovale was enlarged. The tricuspid valve was normally positioned, with dysplastic, thick and stiff leaflets. The chordae tendinae were thick and stiff. The right ventricular chamber was dilated, with numerous prominent trabeculations and deep intertrabecular recesses in the apical and mid portions of the right ventricular wall (Figure 1). The anterior wall of the mid part of the right ventricle showed focal aneurysmal dilatation. The outflow tract of the right ventricle was normally formed. The pulmonary valve was normal. The left atrium was of normal size and shape. The mitral valve was slightly hypoplastic (mitral valve annular circumference was 7.0 mm, expected 10.0 mm), but otherwise was unremarkable. The left ventricular chamber was slightly decreased in size, with thick left ventricular free walls (4.0 mm, expected 2.0 mm). The aortic valve was mildly hypoplastic (aortic valve annular circumference was 5.0 mm, expected 8.0 mm). The external diameter of the ascending aorta was slightly small (3 mm) and that of the main pulmonary artery trunk was slightly enlarged (4 mm). The aortic arch and head-neck vessels were normal. The ductus arteriosus was patent and normally formed. The left and right pulmonary arteries were normal. The anatomy of coronary arteries of the heart was normal. Measurements from the epicardium to the endocardium excluding papillary muscle in 4 quadrants of both the left and right ventricles at the level 0.5 cm below the atrioventricular valve annulus were performed, including anterior, lateral, posterior wall thickness and interventricular septal thickness. (Left ventricle: anterior 3 mm, lateral 2 mm, posterior 4 mm, septum 3 mm; Right ventricle: anterior 1 mm, lateral 1 mm, posterior 2 mm). Heart weight was evaluated in relation to expected heart weight for the gestational age. (Heart weight 1.76 gm, expected for 19 weeks 1.7 +/- 0.7).